Addressing disparities in tobacco-related diseases by understanding the tobacco industry strategies

点击翻译按钮获取中文摘要

ABSTRACT Tobacco use is the leading preventable cause of death and is responsible for a third of cancer deaths in the US. Tobacco-induced diseases and mortality are not equally distributed. Racial, ethnic, gender and sexual orientation minorities, as well as those living below the poverty line and with lower levels of education, have disproportionately higher rates of tobacco use and higher rates of tobacco-induced cancers. Tobacco control policies to date have not adequately addressed these inequities. The tobacco industry is the vector of tobacco- induced disparities. Therefore, reducing the burden of tobacco-induced disparities requires understanding how the industry targets minority communities and cultivates social, policy, and regulatory environments favorable to tobacco use. This understanding is ever more important as the landscape of tobacco products is evolving rapidly as tobacco companies expand their portfolio of products and reposition themselves as providers of tobacco harm reduction. The number and diversity of tobacco and nicotine products is increasing to include electronic cigarettes, electronic pod devices, heated tobacco products, and other nicotine vaporizers. Tobacco and the electronic cigarette companies are also expanding into the cannabis business. The impact of this expansion in exacerbating existing tobacco-related disparities is unknown. Policymakers face a new challenge in promoting tobacco-related health equity: responding to tobacco industry opposition to regulation while developing interventions appropriate for novel tobacco products, and increasingly, cannabis products sold by the same companies. However, local policy innovations are being implemented. We will explore how policymakers consider different policies in attempting to decrease health disparities. We will use industry documents, key informant interviews, publicly available policy documents (e.g., public hearings), published reports, and news media, to pursue three Specific Aims: 1)Analyze evolving tobacco industry strategies, in collaboration with third parties and allied industries, to influence public health policies and tobacco product regulations in ways that exacerbate health disparities; 2)Understand tobacco industry marketing strategies that seek to normalize nicotine use (including in new tobacco and nicotine products) and communicate claims of reduced risk, and how these target racial/ethnic minorities and other vulnerable groups; and 3) Analyze innovative local- and state-level tobacco and cannabis policies to understand how diffusion of these policies and interaction between them can support the reduction of tobacco-related health disparities and promote equity. This unique scientific contribution can inform future public health programmatic, policy, and regulatory strategies addressing the evolving industry and products while focusing on health equity.